Provider Demographics
NPI:1093240905
Name:WASHINGTON, TATIANA CAMILLE
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:CAMILLE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 OXON RUN DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1122
Mailing Address - Country:US
Mailing Address - Phone:301-646-1229
Mailing Address - Fax:
Practice Address - Street 1:2623 OXON RUN DR
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1122
Practice Address - Country:US
Practice Address - Phone:301-646-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 220184-9163W00000X
MDR187865163W00000X
DCRN1017924163W00000X
CA95050441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse